Journal of the American College of Cardiology

VALUE OF DOPPLER-DERIVED ACCELERATION AND EJECTION TIMES FROM RESTING TRANSTHORACIC ECHOCARDIOGRAPHY IN DISCRIMINATING TRUE SEVERE FROM PSEUDO-SEVERE STENOSIS IN THE SYNDROME OF LOW-FLOW LOW-GRADIENT AORTIC STENOSIS

Author Information

Adrian A. Chong,

Kim A. Connelly,

Jeremy M. Edwards,

Alison L. Hokkanen,

Chi-Ming Chow and

Howard Leong-Poi

Background

Undifferentiated patients with low-flow low-gradient aortic stenosis (LFLG AS: AVA<1.0cm2, LVEF<40%, mean gradient (MG)<30-40mmHg) have a poor prognosis and high surgical mortality. Identifying those with true severe AS (TS) who would most benefit from aortic valve replacement (AVR) from pseudo-severe AS (PS) remains challenging. The projected AVA (pAVA) has reasonable discriminatory value but still requires dobutamine stress echocardiography (DSE) that may be poorly tolerated in this high-risk population. We aimed to determine if the acceleration (AT) to ejection time (ET) ratio (AT:ET) is able to separate TS from PS.

Methods

A retrospective review of all DSE studies performed in a tertiary echocardiography laboratory for the assessment of LFLG AS was conducted. Standard averaged Doppler measurements for AS severity and systolic timing intervals (AT, ET and AT:ET) were recorded. Stroke work loss (SWL), valve resistance (VR) and pAVA were calculated for reference. Working definition for TS was a final AVA<1.0cm2 and/or MG>40mmHg (with AVA<1.0cm2) with/without contractile reserve (stroke volume (SV) increase >20%).

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VALUE OF DOPPLER-DERIVED ACCELERATION AND EJECTION TIMES FROM RESTING TRANSTHORACIC ECHOCARDIOGRAPHY IN DISCRIMINATING TRUE SEVERE FROM PSEUDO-SEVERE STENOSIS IN THE SYNDROME OF LOW-FLOW LOW-GRADIENT AORTIC STENOSIS